| NPI | 1184173858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301502624) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 297205-1) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.027428) | |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-01-31 |